title: Comparative efficacy and acceptability of antidepressants in Parkinson's disease: a network meta-analysis.
abstract: BACKGROUND
  Depression is a common non-motor symptom in patients with Parkinson's disease (PD). There are many kinds of antidepressants being used, such as tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and Dopamine agonists which are suggested as alternative antidepressants for the treatment of depression in PD. Which one should we choose first? Literatures have shown inconsistent results.
  
  
  METHODS
  We conducted a network meta-analysis of randomized controlled trials to compare the efficacy and acceptability of therapeutic methods for the treatment of depression in Parkinson's disease.
  
  
  RESULTS
  We used the odds ratios (OR) as effect size firstly and the results indicated no statistical significance between each compared intervention. Then we used the logarithm of the individual odds ratios as effect size. With efficacy of TCAs as the standard of comparison, the degree of incoherence (a measure of how closely the entire network fits together) was small (ω =  4.824827e-05). The logor were: SSRIs -0.69 (95% CI -1.28- -0.10); Pramipexole -0.73 (-1.71- -0.26); Pergolide -1.97 (-3.67- 0.27); SNRIs -0.86 (-1.86- 0.15); Placebo -1.24 (-1.99- -0.50). With Placebo as the standard of comparison, the logor were: TCAs 1.24 (0.50- 1.99); SSRIs 0.55 (-0.03- 1.13); Pramipexole 0.51 (-0.12- 1.15); Pergolide -0.73 (-2.25- 0.80); SNRIs 0.38 (-0.42- 1.19); TCAs, pramipexole, pergolide and SNRIs showed better profile of acceptability, leading to significant fewer discontinuations than that of SSRIs.
  
  
  CONCLUSIONS
  There is insufficient evidence to support antidepressant efficacy for SSRIs, pramipexole, pergolide and SNRIs. TCAs might be the best choice when starting antidepressant treatment in patients of Parkinson's disease because it has the most favorable balance between benefits and acceptability, followed by pramipexole and SNRIs, SSRIs might be the last choice.
authors.affiliation: Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: Jinling
authors.initials: J
authors.lastname: Liu
authors.forename: Jiangchuan
authors.initials: J
authors.lastname: Dong
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Ying
authors.initials: Y
authors.lastname: Su
authors.forename: Peng
authors.initials: P
authors.lastname: Yan
authors.forename: Shenggang
authors.initials: S
authors.lastname: Sun
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D052160:Benzothiazoles / Q000627:therapeutic use*; D003863:Depression / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D016017:Odds Ratio; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D010479:Pergolide / Q000627:therapeutic use*; D000077487:Pramipexole; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D052160:Benzothiazoles; D010479:Pergolide; D000077487:Pramipexole; D017367:Selective Serotonin Reuptake Inhibitors